but something was said earlier today which draws me to have a flashback to kind of make a point about how much we've tried on this side to contribute to improvements in health care and better access for all. the very distinguished majority whip commented that he had talked to some realtors and that one -- three in four realtors were uninsured and this bill was going to help they will. the the reason is they're not able to form risk groups together associated and affiliated as a like practice. because of the i.r.s. code, the company's employer, who has independent contractors working for them, cannot, by law, provide them with medical insurance. in 2006, on the floor of the united states senate, 57 republicans and democrats offered and voted for the associated health care bill, or the small business access to health reform. 57 out of 100. we needed 60, just like this

bill needed to get to cloture. that bill would have allowed associated professions to join together, compete for insurance nationwide, form risk pools that are large enough to mediate and ameliorate high rates. and so he was correct in his statement. the reason they don't is that they have to buy in the spot market because they can't have a group plan. when they buy in the spot market, they're talking abou about $1,800, $2,000 a month, which is unaffordable and unsustainable. this bill does nothing to address that. this is one of the holes in the uninsured. those insured are going -- uninsured are going to be those type of people. i was proud to be part of the 57, along with the other distinguished senators on the floorks and a number of democrats. there have been lots of efforts made by people on both sides to

get better access to health care, but, unfortunately, they've been blocked all over this philosophical argument whether it will be government provided or competitive in the private sector. the shift of state is moving toward the government provision, with this legislation, which is one of the reasons i oppose it. i turn it back to the distinguished senior senator from georgia. mr. chambliss: i rise, really, to pose a question to you. i ask my colleagues to comment on their state. you served in state legislature for many years and you're familiar with owsh schip program -- our schip program, called peach care and the rising medicaid cost we've seen in our state. and what this bill does in seeking to reach out, as i understand, is to expand the egg eligibility for medicaid. and raises the eligibility level from 100% of poverty level to

150% of the poverty level. that's going to have a huge impact on every state that is going through difficult financial times. we, in georgia, we had a $3 billion shortfall this past year that had to be plugged. i saw the other day in the press where we have almost another $2 about. our legislature is going to have to deal with next month, in reducing services around our state, and every state is having that same experience. but, yet, what this bill does is to put a mandate on states to increase the amount of money that states put into medicaid, and i know you're very familiar with that and i'd ask you to comment on that. eye. mr. isakson: it's what is known as an unfunded mandate. let me put some meat on that bone. the state of georgia this year had a budget of $17 billion and the medicaid portion -- justed medicaid portion in georgia was over $2 billion. so it's approaching, getting close to 16%, 17%, 18% of the

entire budget. if this bill passes raising the eligibility from 100% to 150%, than in 2017, georgia would go from 2-point -- $1.00 - -- $2.15 billion to over a quarter of billion -- that is a recipe for disaster. in our state, like 43 other states in the united states, can't borrow money. we have to have a balanced budget. and if the federal government man dates that we spend $3 billion, we have to cut it out of someplace else in our state like he education or our prisons or park systems or somewhere else. you know, it's really ironic, senator chambliss, that you asked me that question, because this morning as i was preparing to come over, i had the television on, and arnold schwarzenegger, the governor of california, was being interviewed. he raised the questions that the

provisions in this amendment will raise by $3 billion the cost of medicaid just in the state of california. a state that last year had to have $6 -- had a $60 billion shortfall and he estimates next year will have a $20 billion shortfall. if we continue in washington to mandate funding and don't put our money behind it, we're pushing our states to the brink of bankruptcy where a number of them already are. and it's not fair to say we're covering more people when we're bankrupting our state. we're not covering anybody if we're pushing the cost off on someone else. so i appreciate the senior senator from georgia raising that point and i associate myself with governor schwarzenegger and his remarks this morning about urging us not to force unfunded mandates on our states. the senator from texas? mr. cornyn: if i could respond to the senior senator from georgia and the junior senator from georgia, my state, this is

a $20 billion unfunded mandate. $20 billion. of course, we know -- at least we read and hear from some in the press that not all states will be treated the same. and that that was, in fact, an inducement on the part of some senators to vote for the bill to be one of the 60 votes because they were either going to get a sweetner in terms of being held harmless for at least a portion of that, or in the case, i guess, of nebraska for all of it. and what strikes me as fundamentally unfair, but also demonstrates -- the flaw and the way this bill has been noartd. in order to try -- negotiated. in order to try to get to the 60 votes, there has been basically a pay to play approach to this. and it's just repulsive, frankly, to me and to my constituents who wonder what kind of games are going on here. the senator from south carolina, i know, has some thoughts about

that. gramr. graham: the inflationary cost of the government is unsustainable. medicare and medicaid as the senator from georgia indicated, are becoming huge programs that are unsustainable. medicare is $36 billion underfunded. what does that mean? over the next 75 years, the benefits promised, there' there's $36 trillion short of money to pay those benefits, and that's got to be dealt with. what we're going to medicare to not better, it's worse. medicare is a matching program. listen to this if you're out there on a sunday with nothing else to do but listen to me. if you don't live in nebraska, here's what's coming your way. your state is going to be required to cover more people under medicaid because the eligibility, i think, goes up to 133% above poverty, which is an increase over the current system. so throughout nation, there are going to be thousands of more

people enrolled into medicaid. and every state, except one, is going to have to come up with matching money. i have 12% unemployment in south carolina. my state's on its knees. i have 31% african-american population in south carolina. how did they get the 60th vote? it was the weekend before christmas and they were one vote short. well, here's what they did to get that one vote. they had a deal cooked up that no one knew about but the two people talking. there was no input from anybody other than the majority leader and the senator from nebraska. and after that meeting was over, they come up with a 380-page amendment to a 2,000-page bill. they file it yesterday. we make them read it -- hear about it for the first time yesterday. the majority leader fills up the tree so that there is no ability by any republican or democrat to

amend their work product. and this is a transparent, new way of doing business? you cook up a deal in a backroom that essentially -- that's essentially sleazy, in my view, to allow one state to be held harmless for medicare enrollees to get that vote and make the rest of us go home and say, why can't you in south carolina and georgia get that deal? what kind of senator are you? well, i'll tell you, this is the kind of senator we are. we're not going to do that. we're not going to put the whole nation at risk and take a broken system and make it worse just to get above. no way. abortion, you're either for it or against it, you're indifferent to it. you can be whatever you want to be on abortion and be just as good of an american as i am. i'm pro-life and proud of us. most of us whether pro-life or

pro-choice don't want our taxpayer dollars to be used to pay for abortion. the hyde amendment has prevented taxpayer dollars to be used for abortion. well, in this health care reform, guess what? that's exactly what's going to happen. there's a brave democrat in the congress, bart stupak, from a blue state, who stood up to his democratic leadership and said i will not vote for a bill that allows federal taxpayer dollars in the form of subsidies to be used to fund abortion because i find it morally offensive and i think most americans agree with me. he brought the house to its knees. saying you will not pass this bill to use federal dollars to fund abortion. what did he get out of it? nothing. not one thing for wisconsin. he got out of that deal the pride of knowing that he stood up for the unborn.

the bill comes to the senate. senator nelson from nebraska tries to introduce the stupak language that would be an absolute bar from using your taxpayer dollars to fund abortion. he lost that amendment. he said he could not vote for a bill that would allow taxpayer dollars to be used to fund abortion. he gets in a room with senator reid, and he comes up with a compromise. and he claims it solves the problem. well, the problem is that his claim is not accepted by all those who follow this. that the compromise he has achieved on abortion is a miserable failure. congressman stupak says it's unacceptable. the national right to life committee says it's unacceptable. the nebraska right to life committee says it's unacceptable. the council of catholic bishops says it's unacceptable. there is not one pro-life group

in this country who believes that senator nelson protected the rights of the unborn. now, how in good conscience do you vote for a bill when that was a big issue? at the end of the day, one last thought, this bill would make an enron accountant blush. they're talking about how it lowers the defendant sit b by $130 billion. but they don't tell you that t the $247 billion doctor fix is not in the bill. what am i saying? over the next 10 years doctors, under the 1997 balanced budget agreement, will have 247 - -- $247 billion taken out of their practice unless congress acts. since 1997, congress every year has stepped up to the plate and forgiven that cut, which is double digits. everybody knows we're going to

do that. but -- and when it came to health care reform, they left the doctor fix out because if you include it, it no longer is revenue neutral. it doesn't prevent the -- it no longer does what they say. they say it cuts the deficit b by $132 billion, but if you include the $247 billion, it runs up the deficit in the first 10 years and in the second 10 years it adds $2 trillion to the deficit. long story short, this is what enron did. people went to jail for doing this in the private sector. they took the liabilities of the company and they hid them making the balance sheet look better than it actually is. so when they tell you this reduces the deficit b by $132 billion, they took out a liability that they know we're going to fund, just it cook the books. if this is going to be okay for the country, then we have no hope as a nation of ever solving

any hard problems. and i just would like to say to my colleagues, i know you want to be home. i know everybody on the other side wants to be home. i know you want to find ways to solve hard problems. people in afganistan want to be home too. at least they're away from home for a noble purpose. we're up here trying to stop a legislative process that if it becomes legitimate, if this becomes the okay way of doing business, giving one senator a deal you won't give anybody else and put the whole country at risk just to get that vote, then i hope the american people will rise up and righteous -- in righteous indignation an throw us all -- and throw us all out. nobody should be representing the country this way. mr. cornyn: the senator -- mr. chambliss: the senator from south carolina raising a point about this bill being revenue neutral and decreases the deficit. how do they achieve that?

they achieve that through truly enron accounting, as the senator from south carolina just said. here's what happens, there is a certain amount of money that is projected by c.b.o. to be generated and insurance premiums being paid by young individuals across this country under what's called the class act. the class act is a new medicare -- new health care generated program, a new entitlement program that's included in this bill. and what it says is, and it's going to provide long-term care benefits for young, healthy americans who ultimately are going to become invalid and need that long-term care. well, the fallacy in the numbers game that's being played here is that they are saying c.b.o. -- c.b.o. is saying that it is true that there will be a projection that we're going to say will generate -- a projection that they're using saying we're going

to generate premiums from these young people who are not going to be entitled to the benefits under this bill for 20, 30:00, 40 years from now but even c.b.o. recognizes that when these benefits begin being paid out, there's going to be an entitlement created that's going to blow the budget of this particular new program all the way out the top. in fact, the chairman of the budget committee, the democrat from north dakota who i admire and respect so much, has even said that this particular provision in this bill is a ponzi scheme, it's something that bernie madoff would love, and yet here we are with straight faces on the other side of the aisle coming in and saying, we're really going to reduce the deficit by passing this provision called the class act. beyond me how anybody with that straight face can say that that is actually a fact.

a senator: would the senator yield? mr. chambliss: absolutely. mr. isakson: isn't it true that's what's wrong with social security today, where we've spent it for years and years rather than putting it in a trust fund. and now that the baby boomers are going, the money's not there? isn't that the same thing? mr. chambliss: you are exactly right and exactly the same situation with medicare. mr. isakson: just one other question to follow up on the fiscal part that senator south carolina brought. it's also true that the taxes begin in 11 days in this bill, january 1 of 2010, but the benefits begin january 1 of 2014. and in that score of the first ten years of costs, you've got four years of program that aren't costing anything while you're raising revenue. so it's a ruse and a masking of the actual fiscal effect on the united states of america. mr. chambliss: the only way that senator reid could get the score that he kept going back and forth with congressional budget office on was to make sure that the taxes started immediately, and they will. he's increased taxes by $26 billion to come up with a

proposal he says is revenue neutral. that's an additional $26 billi $26 billion, so it makes it a total of $518.5 billion in new taxes that are going to be paid by hard-working, tax-paying americans and no benefits under this bill are going to start accruing until the year 2014. mr. cornyn: will my friend yield for a question? mr. chambliss: absolutely. mr. cornyn: i would just ask the senior senator from georgia, you remember this statement by president obama. he said, he won't sign a plan that adds one dime to our deficits, either now or in the future. period. yet david broder, perhaps one of the most respected journalists here in washington, d.c., who's been around a long time, he said, he's talked to all the experts and everybody he's talked to said that these bills as they stand are budget-buste budget-busters. and, of course, i'm sure the

senator also remembers a "washington post"/abc poll that said that 66% of those who responded to the poll think that this bill will make the deficit worse, not better. in other words, we've got a credibility problem between what is being promised here by the president and presumably by the proponents of this bill and the american people because they simply don't buy it, they don't believe it. maybe that's why that earlier number from the rasmussen poll said that a majority of americans don't want us to pass this bill but rather want us to start over and take a step-by-step or incremental approach. mr. chambliss: well, there's just no question but that the american people understand this. they get it. when we talk about cutting medicare by $450 billion, do they really not think that the quality of care under medicare is going to be diminished? of course it is.

do the american people really think that we're not going to have an increase in the deficit when we're going to have almost a trillion-dollar bill in real, live dollars that's going to be passed by this body in the next couple of days, in all probability? sure, the american people get that. they -- they know that this is going to increase the cost of health care and it's going to increase the deficit. and that is -- that's why they're oh posted to this. mr. graham: would the senator yield for another question? mr. chambliss: sure. mr. graham: that's talk about class act a little bit more. it's a new program that doesn't exist today where the federal government, as i understand it, will be offering long-term health care insurance to the american people. it's a voluntary program at first, just like everything else around here. guess who's going to sign up? it's called adverse selection. the sickest people in the country are going to sign up. under the bill as it's written, it's just like what senator isakson said about the

underlying bill. you collect taxes for ten years, you pay out benefits for six. that's the way you get the money to make the numbers come out right. well, guess what happens in the class act, this new program no one's heard much about? you start collecting premiums in 2011 but you don't pay any benefits until 2016. guess what happens? that generates $73 billion of money to be used to say to the american people, this bill is paid for. but when you ask the c.b.o. about what happens after 2016, they say by 2029, i think it is, the whole thing falls apart because the only people in the program are the sickest folks because it's a voluntary progr program, and at the end of the day, you've created a new entitlement and everybody in this body is going to be rushing to subsidize premiums and get more people into this system. it will be another entitlement that grows and c.b.o. says it will be a deathblow to our fiscal soundness.

so i would ask the senator from georgia, when senator conrad, who we all respect, said this is a giant ponzi scheme that bernie madoff would have been proud of, do you think that's what he meant, you collect premiums and you make it look like you -- you have money you really don't have and you put off paying out benefits? and at the end of the day, would the senator agree with me, i've got a letter from october 23, 2009, from senator conrad, landrieu, lincoln, warner, lieberman, bayh, and nelson to the majority leader saying please take the class action out of the bill. would the senator agree that the class -- please take the class act out of the bill. would the senator agree that the class act is still in the bill and that anybody who votes to send this off to the froze become law -- president to become law has become a coconspirator to the giant ponzi scheme? mr. chambliss: i don't think there's any question about, that the senator is exactly right. and it's what we call in washington, fuzzy math.

utilization in one pocket to pay for something on the other side. and at the end of the day, it just doesn't add up, and the senator from north dakota was exactly right, it is a huge ponzi scheme. and i'd ask unanimous consent that the letter dated october 23, 2009, just referenced by the senator from south carolina be introduced into the record. the presiding officer: without objection. mr. cornyn: i wonder if the junior senator from georgia would yield for a question? mr. chambliss: absolutely. mr. cornyn: since we have a unanimous consent agreement for a colloquy here. you were talking about this a little bit earlier but one of the things that i think has not been adequately discussed because of the way this bill's been railroaded and because we've been denied an opportunity to offer amendments and we'll be voting on the bill on christmas eve, as it currently is scheduled, but i want to ask you witabout the impact on business. you were in the real estate business and employed a number of people in your company. you had to meet a payroll and

make sure that the -- that you ended up in the black and not in the red. but one of the things that the national federation of independent business has said, that this bill will actually increase health care costs for businesses and the cost of doing business. i can't imagine anything worse we could be doing during a recession, during a time when unemployment's at 10%, than making it more expensive to do business and, thus, keep people on your payroll. won't it be the impact of this with higher taxes, with increased health care costs going to employers that it's actually going to make the unemployment problem worse rather than better? mr. isakson: i think the senator from texas is exactly right. and i'll be the first to say i'm in the process of reading the 400-some-odd page managers' amendment so i haven't read all of it yet. and it does take out the public

option which, by the way, it was originally in and it may still appear at some date in the future. that was a real killer. that raised tremendous costs. in fact, it made it more beneficial for a company to not provide insurance and pay the fine to put people in the government option. but that's not in this bill now and i understand that. but let me tell what you is in the bill. what is in the bill are a number of taxes on a number of small businesses that produce medical devices. and medical treatments. well, now you know as well as die that when the government raises your taxes, you have to raise your price to the consumer. so what does that mean? it's not lowering the cost of health care, it's through the tax mechanism raising the cost of health care either to the insurance company that's in the exchange or to medicaid or to medicare or to the individual person in terms of their co-payment. so you cannot hide the fact that when you're raising the types of revenues, $514 billion, $50 billion a year over ten years, that money is going to ultimately be paid by the consumer of health care.

i mean, it may be paid by the company on its tax return but it's a passthrough cost that they're going to put through to their consumer which, in turn, is going to put more pressure on whoever insures that consumer if, in fact, they're insured. so any time government raises taxes, it raise the cost of living for 9 american people th. that is just a common, well-known fact, and the senator is exactly correct. mr. chambliss: we've talked a little bit about the negotiation that took place behind closed doors over the last few days,is, and it's -- it's unfortunate that we've got tone th gotten tt in this body on this particular piece of legislation where the issue of abortion has injected itself into meaningful and affordable health care reform measures but that's, in fact, what has happened. i, like my friend from south carolina, said, i'm pro-life, we all are, and very proud to be and have strong voting records

on that. the law of the land in the united states of america for well over 30 years has been that no federal funds should be used to fund abortions. and, you know, it makes no difference whether you're in one part of the country or the oth other. that is the law. that's the way it ought to be and it ought to -- it ought not to be changed because we've had any number of votes on abortion issues over the years. and in every instance, we have failed to pass a law that would provide for the use of federal funds for abortions. that's changing, irrespective of what the senator from nebraska thinks he negotiated. that's changed. i have three letters that i wish to enter into the record here. one is pretty because it's from a group of african-american

ministers in my home state. and this group is headed up by bishop wellington boone. and bishop boone wrote me this letter yesterday, and here's part of what he says in here. he said, "we cannot emphasize enough that abortion is not health care," and he's absolutely right. there's also a -- a letter from a young lady, cindy o'leery, who runs -- she's executive director of the hope center in woodstock, georgia, who is just appalled at the discussions and the fact that we now are going to be using federal money to fund abortions. and also a letter from cadie fields, the director of georgia christian alliance, imploring us not to pass any kind of bill that sets the precedent of providing federal funds for the use in abortions. and i would ask unanimous consent to enter those letters

into the record. the presiding officer: without objection. mr. chambliss chambliss: and in, let me just say, madam preside madam president, that the senator from south carolina said it very strongly but he's right. we've reached a new day in this body. we've had deals cut behind closed doors that are going to provide benefits for individual senators in their states, whether it's vermont, new hampshire, nebraska, florida, or wherever that's going to require those of us who didn't have opportunity to participate in discussions and negotiations on this bill to represent our citizens who are going to have to pay more for services that everybody all across america gets. there's nothing right about that. there's nothing fair about that. and i dare say, i -- i have some relatives who live in nebraska. they've got to be embarrassed and ashamed about this because

they're going to be getting a huge benefit simply because the democrats needed 60 votes to pass the health care bill. and with that, madam speaker, i see -- mr. graham: one last thought, if i may. mr. chambliss: sure, just close us out. mr. graham: i know that there are good, hard-working people all over the country, particularly in nebraska's and a lot's been said about nebraska, and i just hope the people of nebraska will speak up and be heard. this is not over. they may get 60 votes in the next couple of days but this is not over. we're going into the fourth quarter, and the most valuable player on our team is the american people. speak up, speak out. if you don't like what's going on. if you don't like the phony baloney accounting, if you're upset about your taxpayer dollars being used to fund abortions, speak up. if you think there is a better way to do business, let us know

about it. it has a long way to go. it has to go back to the house. one senator indicated that the house better take it or leave it. that's not good government. that's not the way it works. the three of us have been in the house. i want you to know that this is far from over. public opinion matters to us all. so to the american people who are concerned about this being a done deal, it is not. you can change the outcome. i hope you'll get involved. because at the end of the day, it is your country that we're talking about. a senator: madam president? the presiding officer: the senator from montana. mr. baucus: madam president, it has been more than a month since the majority leader moved to proceed to the health care bill before us today.

this bill will provide real reform for our nation's flawed health care system. this bill is a product of years of hard work, study, deliberation in both the finance committee and the "help" committees. and i mean years. all transparent, all above board, out in the open. in fact, the finance committee, might add, mr. president, we even initiated a new requirement that all amendments to the bill be posted to us in advance and put on the internet in advance so everybody could know what they were. same thing with the bill, it was on the internet for a couple, three days before we went to markup. unprecedented how open the process has been and the same is true in the "help" committee as well. the culmination of these efforts has been the weeks of debate that we have heard on this bill and the weeks of debate that we've on this bill on the senate

floor. it has been weeks. it's been over a month. it is true, there could be some minor changes here and there. but most of this has been in the public domain for a long time. we've considered numerous amendments. we've engaged in full and healthy discussion. the bill before us is fully paid for. it is important to keep reminding our colleagues over an over and over again -- and over again, this is fully paid for. fully paid for. don't take my word for, it that's what the congressional budget office said. fully paid for. the american people, i hope and realize, that according to the congressional budget office, nonpartisan organization, this bill is fully paid for. it doesn't add one thin dime to the deficit. others who don't have their own proposals, want to be negative, want to try to shoot holes in this. trying to say it has a deficit. that's their opinion, that's not the congressional budget office. the c.b.o. said that it does not add one thin dime. this bill will also reduce the

federal deficit in the short term and over the long term. it reduces the federal deficit in the short term and long term. we are so very concerned about our deficits, madam president, we in the congress are, the country is, we've got to begin as soon as we can to start getting the deficits down and our national debt lowered. this health care reform bill, not only does it provide health insurance coverage and reform the health insurance industry very dramatically, it also takes that step of lowering our deficits and lowering our long of this term debt. let me quote from the congressional budget office letter that came to us yesterday. quote, "c.b.o. and j.c.t., estimates that on balance the direct spending and revenue fix of enacting the patient protection and affordable care act, the health care bill, incorporate in the managers' amendment would yield net deficits of $132 billion over

the next 10 years. net reduction of $132 billion. that's even better, madam president, than the merged bill was just before we concluded the managers' amendment. that was a $132 -- that wa was $130 billion reduction in the national deficit. now the managers' amendment incorporated in the bill, according to the congressional budget office and joint committee on tax concludes there is a net reduction in federal deficits of $132 billion over a 10-year period. what about later? often people say, oh, gee, i hear you, senator. you're taking care of things in the short term. you are enacting legislation that will have a long-term effect. you hear that often. let -- let me tell you what the congressional budget office says about that. this legislation before us now will reduce the deficit marketedly in out years. here's what the c.b.o. said in a letter released just yesterday -- excuse me.

released today. i have lots of letters from c.b.o. quote, all told the congressional budget office expects that the legislation, if enacted, would reduce federal budget deficits over the decade after 2019 relative to those projected under current law with a total effect during that decade that is in a broad range -- that is in a broad range between one-quarter percent and one half percent of g.d.p. what are they saying? the second 10 years the deficits will be reduced between a quarter percent and half percent of g.d.p. that's between $630 billion an and $1.3 trillion. that's a lot of money. if we're going to reduce the federal deficit just by this legislation alone, let's take the mid point between -- let's say $1 trillion, in the next decade, that's important. that's significant. that's a good start. so this will extend insurance coverage, and also this legislation before us will

extend insurance coverage to more than 30 million americans. just think of that. 30 million americans who today do not have insurance will get health insurance. that is so so important. i forgot the exact figure, madam president. there was a harvard study that concluded that -- that 45 -- i think -- i've forgotten the figure. thousands of americans die every year because they have no health insurance. because they don't have health insurance. obviously people without health insurance die at an earlier age. just for the sakes of their own health, -- sake of their own health, that they get health insurance, let alone the benefit that has with hospital -- by reducing uncompensated care at hospital. this legislation will increase insurance coverage to more than 30 million americans, and i have just been passed a note that people have a 40% higher chance of dying without health insurance. 40% higher chance of dying if they don't have health

insurance. we're saying to those folks, those 31 million americans, we're going to figure out a way to get health insurance so you don't have to 40% higher risk of death. okay, here's what c.b.o. says about coverage. quote, by 2019, the c.b.o., joint committee on tax, estimate that the number of noneligible people not insured will be reduced by 31 million. the c.b.o. goes on to say under the legislation the share of legal nonelderly residents would rise from 33% currently to 94ern. that is 94% of the people in our country, excluding seniors, excluding -- because they have medicare and excluding unauthorized documents, they're not here because they're not authorized, the total number will rise from 83% up to 94%. and this legislation will drive down premium costs for virtually

all of us. it will drive down premium costs for virtually all. in an earlier letter, the congressional budget office indicated that premiums will go down for roughly 93% of americans. that's -- that's the underlying bill. premiums will go down 93% for americans. it's in the letter. i was going to put a table, madam president, in the record a couple, three days ago, our rules don't allow us to put tables in. i had to summarize and that is 93% of americans will experience lower premiums. not dramatic for some -- some folks, but none the h nonethele, and down is better than not down. insurance costs would go down sig antly for those receiving tax credits in the new insurance exchanges. it will protect consumers from harmful insurance company practices. this is so important, as you know, madam president. no longer will insurance companies be able to deny coverage for those with preexisting conditions. it's an outrage how much insurance companies deny coverage based on preexisting

conditions. an absolute outrage. we all hear stories many, many times, if not from family members, friends of families, we run into this so common, especially in the individual market, that is, people who buy insurance for themselves, insurance companies denying coverage to -- deny giving health insurance to somebody because of some preexisting condition. it is just wrong. no longer will insurance companies be able to drop coverage for those who are sick. that's very important too. companies often rescind, willy-nilly, they find a background of the person, oh, you didn't tell us about that, so we're rescinding your policy. that's not right. that's just not right. and we prevent that from happening in this legislation. it will also improve choice and competition in the insurance market. we talked a lot about choice, we talked a lot about competition. this legislation provides more choice in choosing policies and more competition in the insurance market. it will also create a true marketplace where plans complete

on cost and quality rather than on their ability to cherry pick the healthiest among us. and it will represent the largest tax cut for the american families that congress has passed since 2001. let me repeat that. this legislation includes the largest tax cut for american families that congress has passed since that tax cut bill in 2001, the largest. it's all of those tax credits that people received, helped them buy insurance. that totals up, i think, madam president, to $440 billion. i forgot the exact figure. this is the largest tax cut for the american families that congress has passed since 2001. it will provide tax credits by quality, affordable health insurance. the managers' amendment makes this good bill even better. it will provide even more consumer protections against harmful insurance industry practices. for example, it will hold companies accountable for

excessive premium rate increases. it will require them to spend more on consumer benefits and less on administrative costs and profits. that's new. that's even better consumer protection for -- compared with the -- with the underlying bill. it will restrict the ability of health plans to -- that's new. restricting the ability of health plans on annual limits on benefits. that's wrong. you get an insurance polls andy the insurance company says, we didn't know you would get that sick. we stop the benefits you will get. and restrict the building of health plans not only annual limits but also lifetime limits on benefits. and this managers' package will ensure that companies cannot discriminate against children with preexisting conditions, and do so right away. beginning with plans that become effective mid year next year. that is the preexisting

condition restriction would ordinarily not take effect for a couple of years, but for children, the preexisting condition prohibition will take affect right away. so they're right away protected. and the other provisions to help people between now and 2014. there's the high-risk poolg, for example, a -- polling, for example, a lot of different protections for people to get protections quickly. this will provide tax credits to more small businesses. the managers' amendment will provide more tax credits than the underlying bill. and these benefits will now be available right away in 20 106789 it's always a concern, gee, when are the tax credits for small business go into effect. shouldn't it go into effect earlier? under this managers' amendment these benefits will be available right way in 2010. this will provide more health insurance choices through a new multistate option. that option offering consumers the same health insurance that congress has today. no small matter.

it will extend extra funding for the children's health insurance program for two additional years. we're all very concerned about kids. kids' health care. the children's health insurance program has done a pretty good job. we want to make sure it stays there so it is extended under the managers' amendment for an additional two years and it will do more to control rising health care cares while more providers have more quality care through the health care program. it will invest $10 billion in community health centers. they're so important, community health centers for people who need help right away and don't have insurance and need the care right away. especially help in rural communities to provide access to critical care for -- who are often -- that care -- where often that care is most needed. these are reforms that americans have been waiting for for decades, madam president. americans are waiting for these changes. they're waiting for these reforms. have been for a long time. decades may be an

understatement. our health insurance system is just -- doesn't do what it should for our americans. for the american people. people who represent. and now, finally we're taking a significant first step to -- to finding those reforms. these are reforms that american families, workers and businesses desperately need. they're reforms on which the economic stability depends. that's no small matter either, madam president. we get our insurance matter under control, that's more economic stability. it's not just for families who don't know what the insurance company is or is not going to do. small businesses don't know whether premiums are going to be up or by how much next year. you know, why? more economic stability for families and small businesses. and soon economic stability for budgets, state budgets, our federal budgets. we just need to get a little more control over the, all the excessive costs that are going

up and also the volatility, the yo-yo effect that premiums have and out-of-pocket costs impositions have on people. this will help very significantly. so by and large, madam president, to be honest, i know it sounds a little naive, perhaps, but i don't know why this bill doesn't get an overwhelming endorsement. this is a big vote on both sides of the aisle. then we can next year keep going from there. new provisions that may be added, correct mistakes that probably this legislation is going to have, but work together because most americans want us to work together back here. they don't like us being partisan or political. i must say this place is getting a little more partisan over the last couple of years than it was earlier. it's not what the american people want. they want us to do our job, do what's right. this bill clearly is the balance of reasonableness of what's right and what's the right thing

to do to get control of our health care system. again, i hope that we can get this passed. madam president -- by a large margin. it will pass, but i'd like to t to pass by a large margin. madam president, i now yield 20 minutes to the senator from rhode island, senator whitehouse. mr. whitehouse: thank you, chairman baucus. the presiding officer: the senator from rhode island. whitehouse as we are here today, -- mr. whitehouse: as we are here, washington rests under a blanket of snow, reminding us of the christmas spirit, the spirit of bringing families together for the holidays. unfortunately, a different spirit has descended on this senates. the spirit that has descended on the senate is one described by chief justice john marshall back in the burr trial, those malignant and vindictive

passions which rage in the bosoms of con tending parties struggling for power. two-time pulitzer prize winner captured this in an essay called the paranoid style. vindictive passions often arise, he points out when an aggrieved minority believes that america has been taken away from their kind. though they are determined to try to repossess it and try to prevent the final destructive act of subversion. does that sound familiar, madam president, in this health debate? 40 years ago he wrote that. hoffstetter continued those aggrieved fear what he described as the now familiar conspiracy. familiar then. 40 years ago. persistent now. whose supposed purpose

hoffstetter is to bring the economy under the direction of the federal government and to pave the way for socialism. again, familiar words here today. more than 50 years ago he wrote of the dangers of an aggrieved right-wing minority with the power to create what he called a political climate in which the rational pursuit of our well-being and safety would become impossible. a political environment in which the rational pursuit of our well-being and safety would become impossible. the malignant and vindictive passions that have descended on the senate are visibly creating just such a political climate. far from appealing to the better angels of our nature, too many colleagues are embarked on a desperate, "no holds barred" mission of propaganda,

obstruction and fear. history cautions us of the excesses to which these malignant, vindictive passions can ultimately lead. tumbrils have rolled through taunting crowds, broken glass has spar keld in darkened street. strange fruit has hung from southern trees. even this great institution of government that we share has cowered before a tail guter waving secret lists. those malignant moments rightly earned what he lord acton called the undying penalty which history has the power to inflict upon wrong. but history also reminds us that in the heat of those vindictive passions, some people earnestly believed they were justified. such is the human capacity for intoxication by those malignant and vindictive political passion

chief justice marshal described. i ask my colleagues to consider what judgment history will intphraoeubgt on this current spirit -- inflict on this current spirit that has descended on the senate. let's look at what current observers are saying as a possibly early indicator of the judgment history will inflict. the editor of the manchester editor inquire editorial page wrote of the current g.o.p. which he called this once great and now mostly shameful party, that it has gone crazy, is more and more dominated by the lunatic fringe and has poisoned itself with hate. he concluded, "they no longer want to govern. they want to emote." a well regarded if i philadelpha columnist wrote of the par know i can't and lunacy on the republican right. the respected phaurpb doud in

her eulogy for her friend william safire lamented the vitriol of the pack of today's pundits. married to a bush administration official, noted about the house health care bill, the appalling amount of misinformation being peddled by its opponents. she called it a flood of sheer factual misstatements about the health care bill and noted that the falsehood peddling began at the top. the respected head of the mayo clinic described recent health care antics as scare tactics and mud. congress itself is not immune. many of us felt president bush was less than truthful, yet not one of us yelled out "you lie" at a president during a joint session of congress. through panics and depressions, through world wars and civil

wars, no one ever has. never. until president obama delivered his first address. and this september, 179 republicans in the house voted to support their heckleer comrade. and here in the senate this month, one of our republican colleagues regretted why didn't i say that? a nobel prize winning economist recently concluded thus, the takeover of the republican party by the irrational right is no laughing matter. something unprecedented is happening here, and it's very bad for america. history's current verdict is not promising. how are these unprecedented passions manifested in the senate? well, several ways. first, through a campaign of obstruction and delay affecting every single aspect of the senate's business. we have crossed the mark of over

100 filibusters and acts of procedural obstruction in less than one year. never since the founding of the republic, not even in the bitter sentiments preceding the civil war was such a thing ever seen in this body. it is unprecedented. second, through a campaign of falsehood about death panels and cuts to medicare benefits and benefits for illegal aliens and bureaucrats to be parachuted in between you and your doctor. our colleagues terrify the public with this parade of imagined horrors. they whip up concerns and anxiety about socialized medicine and car reasons deficits and then -- and careening deficits. then they tell us the public is concerned about the bill. really? third, we see it in bad behavior. we see it in the long hours of reading by the clerks our

republican colleagues have forced. we see it in christmases and holidays ruined by the republicans for our loyal and professional senate employees. it's fine for me, it's fine for the president. we signed up for this job. but why ruin it for all the employees condemned by the republicans to be here? we see it in simple agreements for senators to speak broken. we see it tragically in gentle and distinguished members, true noble men of the senate who have built reputations of honor and trustworthiness over decades being forced to break their word and double cross their dearest friends and colleagues. we see it in public attacks in the press by senators against the parliamentary staff. madam president, the parliamentary staff are nonpartisan professional employees of the senate who cannot answer back.

attacking them is worse than kicking a man when he's down. attacking them is kicking a man who is forbidden to hit back. it is dishonorable. the lowest of the low was the republican vote against funding and supporting our troops in the field in a time of war. as a device to stall health care, they tried to stop the appropriation of funds for our soldiers. there is no excuse for that. from that, there is no return. every single republican member was willing to vote against cloture on funding our troops, and they admit it. it was a tactic to obstruct health care reform. the secretary of defense warned us all that a "no" vote would immediately create a serious

disruption in the worldwide activities of the department of defense. end quote. and yet, every one of them was willing to vote no. almost all of them did vote "no." some stayed away but that's the same as "no" when you need 60 "yes" votes to proceed. voting "no" and hiding from the vote are the same result. those of us on the floor to see it, it was clear the three of them who voted yes did not cast their yes votes until all 60 senate votes had been tallied and it was clear that the result was a foregone conclusion. and why? why all this discord and discourtesy, all this unprecedented destructive action? all to break the momentum of our new young president. they are desperate to break this president. they have ardent supporters who

are nearly hysterical at the very election of president barack obama. the birthers, the the fanatics, the people running around in right-wing militias and aryan support groups, it is unbearable to them that president barack obama should exist. that is one powerful reason. it is not the only one. the insurance industry, one of the most powerful lobbies in politics is another reason. the bad behavior you see on the senate floor is the last thrashing throes of the health insurance industry as it watches its business model die. you who are watching and listening know this business model if you or a loved one have been sick. the business model that won't insure you if they think you'll get sick or if you have a preexisting condition, the business model that if you're insured and you do get sick, job

one is to find loopholes and throw you off your coverage and abandon you alone to your illness. the business model when they can't find that loophole, that they'll try to interfere with or deny you the care your doctor has ordered. and the business model that when all else fails and they can't avoid you or abandoned you or deny you, they stiff the doctor or the hospital and deny their payments for as long as possible or tell their doctor to collect from you first, and maybe they'll reimburse you. good riddance to that business model. we know it all too well. it deserves a stake through its cold and greedy heart. but some of our colleagues here are fighting to the death to keep it alive. but the biggest reason for these desperate acts by our colleagues is that we are gathering momentum and we are gathering strength and we are working toward our goal of passing this legislation. and when we do, when we do, the

lying time is over. the american public will see what actually comes to pass when we pass this bill as our new law. the american public will see firsthand the difference between what is and what they were told. facts, as the presiding officer has often said, are stubborn things. it is one thing to propagandize and scare people about the unknown. it is much tougher to propagandize and scare people when they are seeing and feeling and touching something different. when it turns out there are no death panels, when there is no bureaucrat between you and your doctor, when the ways your health care changes seem like a good deal to you and a pretty smart idea, when the american public sees the discrepancy between what really is and what they were told by the republicans, there will be a

reckoning. there will come a day of judgment about who was telling the truth. our colleagues are behaving in this way, unprecedented, malignant, and vindictive, because they are desperate to avoid that day of judgment. frantic and desperate now and willing to do strange and unprecedented things, willing to do anything, even thousand throw our troops at war in the way of that day of reckoning. if they can cause this bill to fail, the truth will never stand up as a living reproach to the lies that have been told. and on through history our colleagues could claim they defeated a terrible monstrosity. but when the bill passes and this program actually comes to life and it is friendly, when it shelters 33 million americans,

regular american people in the new security of health insurance, when it growls down the most disgraceful abuses of the insurance industry, when it offers better care, electronic health records, new community health centers, new opportunities to negotiate fair and square in a public market, and when it brings down the deficit and steers medicare toward safe harbor, all of which it does, americans will then know, beyond any capacity of spin or propaganda to dissuade them, that they were lied to and they will remember. there will come a day of judgment, and our republican friends know that. that, mr. president, is why they are terrified. mr. president, i yield the

floor. the presiding officer: the senator from montana. mr. baucus: mr. president, i yield 15 minutes to the senator from oregon. the presiding officer: the senator from oregon. mr. wyden: mr. president, thank you, and i thank the chairman for his courtesy as well. mr. president, at this time of the year, millions of americans are out in the stores doing their holiday shopping. that's because we americans enjoy our free markets and our free enterprise system. whether it is a holiday or we are shopping for a car or food or a house, we americans believe that we ought to have quality choices in our marketplace and

americans, our people, ought to be rewarded when they shop wisely. the american economy works this way for just about everything except health care. today american health care is mostly a competition-free zone. insurance companies enjoy extraordinary privileges as monopolies. insurers are exempt from the antitrust laws, and in scores of american towns our people can only get their health care under the heel of just one health insurance company. today's health insurance market is essentially dysfunctional, and for most americans, they have no way to hold the insurance companies accountable.

it has been that way since the middle of the last century. since the days of wage and price controls, literally 60 years plus. the american consumer has not been in the position to be able to hold the insurance companies accountable and to get the value for their dollar that they get in every other part of our economy. changing this broken health care marketplace is the heart of real health reform. now, the legislation we will vote on tonight -- and i might add the chairman of the finance committee is on the floor, and this essentially began with his white paper when we started working on it in the finance committee. the white paper and the legislation that we're going to

vote on tonight -- in my view starts the long march to empowering consumers to turning the tables on the insurance lobby and to get more value for our health care dollar through a part of the health reform debate that got some discussion in the finance committee and then because people liked it and didn't know much about it has sort of gotten lost, and that is the health insurance exchanges. now, for folks listening at home today, an exchange is going to be like a farmers market. various types of health services are going to be marketed through the exchange, and for the first time -- this was an area chairman baucus and i had a great interest in in the committee -- it's going to be possible for folks to make apples to apples comparisons of

various health services. there are requirements that you keep the lousy products out of the exchange, and chairman baucus and i got interested in the need for consumer protection, particularly early on in programs back in the days after medicare got established when seniors were buying 15, 16 private policies to supplement their medicare and most of them weren't worth the paper they were written on. so with these exchanges now, that's not going to happen. people are going to get value for their dollar on day one. and there are also some important consumer protection requirements, and i particularly want to commend the president of the senate. i have been following his work to ensure that now when a consumer pays a dollar in a premium, they're going to get a lot more back in benefits for their dollar. called loss ratios.

people are going to hear a lot about that concept. it's new, but it essentially means that the insurance companies can't walk off with their premium dollar, use it on administrative expenses, use it on salaries, not return it to the public, to the consumer in the form of benefits and services, and i commend the president of the senate, the senator from minnesota, for all of his efforts to ensure that this was put in place. these ideas, in my view, ought to appeal to both democrats and republicans. these market-oriented consumer protection principles, simply because they are just common sense. so should section 10108 of senator reid's manager's amendment, that the majority leader, chairman baucus and i, worked very closely on. it is entitled, mr. president, free choice vouchers. now, this section creates

something that has never existed before. a concrete way for middle-class americans who cannot afford their health care to actually push back against the insurance lobby and force insurance companies to compete for the benefit of those middle-class folks in the insurance exchanges. unlike today, where if a hard-working middle-class american can't afford just the one health insurance policy available to them and thus is out of luck, with this new provision, this new approach, there will be a different health care marketplace with free enterprise choices that can actually drive down costs for the middle class while ensuring that those choices are of good

quality. so the big hurdle, it seems to me, in setting up a new health care marketplace which began with chairman baucus' white paper and in the senate finance committee is getting these exchanges and getting these vouchers in place. we're going to be able to build on it, and in my view, i think we'll have additional opportunities to build on these ideas before the legislation goes to the president. for example, senator collins, our republican colleague from maine, senator bayh and i have written bipartisan legislation that we are working on to include in this legislation that has been endorsed by the influential national federation of independent business. this bipartisan proposal would permit employers who are in the insurance exchange, who voluntarily choose to do so. let me emphasize this, mr. president. this is a matter of a voluntary

choice by employers. if they choose to do so, they could give their workers a voucher so that those workers could shop for their coverage. what this means is for millions of employers and employees, the amendment would provide the choice to have a choice of american health care services. these are unquestionably challenging days for american employers and workers trying to be as competitive as possible in tough global markets. for employers who want more ways to help their workers and the employers' bottom line, and for workers who would like more take-home pay and lower health expenses, this bipartisan amendment can be a life line, and we hope our colleagues of both parties will agree and join our effort, and this can be part of the legislation that ultimately will go to the

president. let me close with this, mr. president. my great hope is that long after 24/7 cable tv has moved on to other topics, the democrats and republicans here in the senate can figure out a new strategy for working together. a bipartisan strategy that will let us together tap the full potential of real health care reform. that potential is for holding down costs, getting more value for our health care dollar, and finally quality, affordable health coverage for all americans. i offer this thought, mr. president, because i have long felt that both parties have valid views on this topic. i believe that our party is absolutely right in saying you cannot fix american health care unless all americans get good

quality, affordable coverage. if you don't do that, too often, uninsured folks will shift their bills to insured folks. there won't be enough prevention. you won't be in a position to get the most value for the health care dollar. i continue to believe that our colleagues on the other side of the aisle have valid points as well. they make valid points about the role of marketplace forces on the role of competition, on the role of choice. there has got to be a way in the days ahead, one of the things that pleases me is chairman baucus has said we'll have a lot of oversight hearings and a lot of work in the days ahead to actually implement this. none of us think that you can create a new health care marketplace where there hadn't been one for 70 years in a matter of minutes. i'm very pleased that chairman baucus has indicated we're going to be doing a lot of the painstaking oversight work in the days ahead to actually implement this transformation in

american health care, and i think the chairman knows that i will be his partner in those efforts to get this implemented. so after a year of tough financial hardships, mr. president, let's find a way to bring to this senate floor bipartisanship, common sense, the goodwill that is public service at its best. i close by saying i look forward to the chairman -- to working with the chairman of the finance committee who i know shares these views as well, and with that, mr. president, i yield the floor. the presiding officer: the senator from montana. mr. baucus: mr. president, i want to thank the senator from oregon for many reasons. one, his kind words which i deeply appreciate, but even much more important than that, it just is his long, long dedication to health care reform. i mean, even back he worked for

the gray panthers before he came here. i remember the name ron wyden, gray panthers, a good number of years ago. then lo and behold, both came to congress together, and we worked together on reforming medigap coverage. it's an outrage. we today, talk about medical loss ratios, 80%, 95% and so forth. under this legislation that insurance companies must adhere to. it was an outrage, the degree to which medigap insurance coverage had medical loss ratios not 80%, not 70%, not 60%. it would be below 50%. insurance companies would sell insurance to seniors to try to cover the gap that medicare would not cover, tragically low, embarrassingly low, outrageously

low. we got together and got together coverage to reform the medigap market, medigap insurance plans. it was unfair. they were ripping seniors o. now in health care reform, ardent advocate, more competition, more choice in our health care system. it's clear we need more competition, it's clear we need more choice. on the competition side, in many of our states we find only one insurance company or two insurance companies that dominate the entire state. it's very true around our country. there is just not the competition there should be. there's not the choice. a lot of employees like to choose sr-rbgs more choice among insurance companies -- like to choose, have more choice among insurance companies. we have a system now where most employees are tied to their

employer. it is pretty much the insurance company the employer offers. if we were to start from scratch, mr. president, maybe 20, 40, 60, 80 years ago, we may not have such an employer-based system as we have today. our current tax code also tends to encourage excessive insurance coverage because of our employer-based system. anyway i'm digressing. senator wyden got us thinking a lot earlier about the problems that caused. i think he's right. a lot of americans think he's right. we can only take things a step at a time here, and we're not going nearly as far as the senator from oregon wants us to go. i want to thank him. he's working hard. on behalf of seniors, on behalf of american consumers with respect to health insurance companies, not letting companies take advantage of systems, i want to thank you, senator.

mr. president, i don't see any other senators on the floor. we're on our side, it would be a good time for them to speak. pending the arrival of other democratic senators, let me say a few things about small business. clearly one of the goals of health care reform is to ensure that employees of small businesses have good-quality, affordable health care options. we all know that's clear. i know when i talk to a lot of small business, i'll never forget a conversation i had with a logger. he's got four or five or six people working for him. i asked if he has health insurance. he said, he does for his family, his wife and himself. i said what about your employer? he said no, he wanted to. it pained him that he couldn't. it was too expensive. we've all her stories like that.

they're legion. i can remember talking to another small businessman in my state of montana, a contractor with five or six or ten people working for him. he was beside himself because the insurance company told him his premiums were going to go up 40% next year. he said, max, i can't deal with that. why are they going up 40%, i asked? they found a preexisting condition with respect to one of my employees. max, i can't afford a 40% increase. they said it would only be a 20% increase if i let him go. he's been with me for 15, 20 years, one of my best employees. i can't let him go. i don't know what to do. i talked to him later and he found another carrier, he kept his employee and he found another insurance carrier. he had to pay 20% more in premiums even though he was able to keep his kpwhraoefplt it's wrong. it's hard for small businesses to find health insurance for

their employees *fplt most jobs in our country are created by small business men. that's where most of the jobs are, most of the creativity is. that's where in many sense where most of the greatest need is that entrepreneurism, american ingenuity where a small business man can do a good job with the service he's providing. last year, mr. president, 62% of small businesses did offer health insurance to their employees. compare that with other companies. that is, companies that have, say, 200 employees. among all companies in america that have 200 or more employees, 99% of them offer health insurance. contrast 62% of small business offer health insurance. 99% of businesses with more than 200 employees offer health insurance. among the very small businesses

in our country, it's lower, lower than 69%. now it's 49%. 49% of very small employees have health insurance through their small business employer. there are clearly very significant reasons for that. there are barriers that prevent small business from finding affordable health insurance options. what are they? well, small business people tell us that the main reason, at least one of them is that the premiums are just too high. i mentioned an example of the contractor i talked with in my state who said they're going to charge a 40% increase in premiums, further evidence that premiums are too hawaii it's understanding -- are too high. it's understandable that's one of the main reasons why small businesses can't get health insurance. in the past ten years premiums have risen 82% for single workers and 93% for families.

virtually double in terms of if you're a single person and work for a small business. as health care costs rise small businesses are forced to make employers work a greater portion of these premiums. in 2008, for example, employees at small businesses that did provide health insurance paid more than twice what they paid just eight years earlier. twice as much. the low rate of offering at higher cost of sharing employees in small businesses often limit the ability of small businesses to attract and retain employees. that is why the health care bill before us includes many provisions to make quality coverage for small business more affordable and for not only business people but for their employees. before the manager's amendment, the bill did include $24 billion in tax credits to help small business and charitable organizations purchase health insurance for their employees.

$24 billion over a ten-year period tax credits for small businesses. the manager's amendment now dedicates additional billions to provide tax credits to small businesses and to make health insurance more affordable. the congressional budget office and the joint committee on tax, which i know is near and dear to the heart of the presiding officer. after all, they are an independent arbiter. they can tell us what objectivity what this legislation is or is not. they estimate that the tax credit for small businesses will provide $40 billion in tax relief to small businesses over the first ten years. $40 billion in tax relief to small business, tax relief for health insurance over the first ten years. in addition, we start the tax credits a year early. that is, we start them in 2010. an earlier underlying bill it was 2011. in the manager's amendment we start next year, 2010, right

away. this means in just over a week after legislation is passed and signed into law, eligible small businesses will be able to receive tax credits to help them buy health insurance for their employees. this expansion of the tax credits means that eligible small businesses will now be able to receive up to six years of tax credits. so now, starting in 2010, eligible small businesses would receive tax credits worth up to 35% of the employer's contribution to employee health insurance plans. 35%. and then in 2014, it's even better. eligible small businesses will receive tax credits worth up to 50% of the employer's contribution to the employee's health insurance plan purchased through health insurance exchanges. so the employer would get 50% of the cost of the health insurance would be available. an employer could credit 50%. that is a fact of his income,

50% of the cost of the premium. that is the effect of a 50% tax credit. what do you have to do to qualify? to qualify for tax credits, businesses must cover at least 50% of employer premium costs. you cover half of the employee costs, you get -- your half, you get to subtract from the income taxes. the value of the tax credit is based on the size of the business and the average wage of the employees. and the manager's amendment expands the small business tax credit. in the manager's amendment the tax credit was made available -- it will be available to small businesses with fewer than 25 employees and less than $50,000 in average annual wages. the full value of the tax credit is now available to small businesses with ten or fewer employees and $25,000 or less in average annual wages. it moved up from $20,000 up to $25,000 so more small businesses

with $20,000 average wages so more small businesses qualify and take advantage of this tax grant. by expanding the wage of threshold, more small businesses will be able to claim their tax credits. the tax credits will phase out more slowly as wages increase. this was a high priority for small businesses. we recognize that and responded to it. the small business tax credit will help make health insurance affordable for many small businesses. how many? in 2011, 4.2 million americans will be covered by quality affordable health insurance because of this credit. in 2011, 4.2 million americans will be able to take advantage of this. on average, small businesses across the country receive a new tax credit of about $4,900 to help them purchase insurance. that is per employee. $4,900 to help them purchase insurance for their employee.

c.b.o. estimates the small business tax credit will help lower insurance costs by 8% to 11% for the employees of small businesses who receive their credit. let meet state that again. c.b.o. estimates that the business credit will help lower insurance costs by 8% to 11% of employees of small businesses who receive the credit. without the small business tax credit, many of these people would have to buy insurance through the exchange on their own, without the benefit of a contribution from their employer. one of the reasons many small businesses are currently unable to afford health insurance is also because small businesses lack the buying power that large companies have to negotiate preferable group rates. the senate bill creates small business insurance exchanges known as shop exchanges, where small businesses can band together and pool their risks which will enhance their choice and buying power. these state-based exchanges will be a critical tool to help small

businesses with fewer than 100 employees to shop around, shop for health insurance plans to determine their eligibility for tax credits to buy health insurance. small businesses that prosper and grow beyond 100 employees would be allowed to continue shopping in the exchanges. pooling. the insurance plans sold in the shop exchanges would be subject to the same transparency requirements and consumer protections that generally apply so that small businesses can feel confident they're purchasing high-quality plans that will provide quality preferable coverage for their workers. the legislation also institutes reforms in the insurance market that will protect individuals and small businesses by purchasing plans both inside and outside these shop exchanges. these reforms will stop insurance companies from denying coverage based on a person's preexisting health condition and increasing health insurance premiums based on health status

generally or on gender or occupation, a practice that has to be stopped. these new regulations are essential to helping small businesses keep health care costs predictable from year to year. that's one of the big problems, mr. president. small businesses face this sea of chaos of volatility, uncertainty, unpredictability, not knowing what their insurance costs will or will not be. it's because the way in which insurance companies cherry pick to take advantage for themselves to maximize their profit has the opposite effect on business. this will help provide a lot more certainty we desperately need. in the changes the manager's amendment goes the extra step to ensure this bill provides small businesses with the help they so desperately need. passing health care reform is critical to small business. without reform, there is no small matter here, i'm not

blowing smoke here, mr. president, without reform many small businesses will be forced to drop their health insurance coverage that they may already have because they can no longer afford it. they cannot afford the increase in premiums. this will leave many employees to fend for themselves in the individual market. we know without this bill passing, how unfair the individual market is to -- to people. the presiding officer: the senator's time has expired. mr. baucus: thank you, mr. president. i see my colleagues on the other side. i ask consent that the balance of my statement be printed in the record at this point. the presiding officer: without objection. mr. barrasso: mr. president? the presiding officer: the senator from wyoming. mr. barrasso: thank you, mr. president. a couple of things. i just heard my colleague from montana talk about jobs that are going to be lost, and the jobs

that are going to be lost are going to be lost if this bill passes. there was an article in "the wall street journal" that quoted a national federation of independent business, a wonderful organization that works so well with the small businesses of this country, and their prediction is that if this passes, if this passes, the mandates in this bill will mandate that employers provide health care. this is going to cost 1.6 million jobs by 2013. and then i got an email from a friend of mine in dubois, wyoming, who said if this passes, he knows he is going to lay off workers. so quite to the contrary of what my colleague from montana said, when he says this is going to help keep people working, at a time when the country is experiencing 10% unemployment, at a time when people's number one concerns are the jobs and the economy of this country, we are now embarking on an additional spending spree when our national debt is at the highest levels ever. so i would disagree with my colleague from montana. i guess that just the contrary

to what he suggested when i think he said, quote -- "i'm not just blowing smoke" -- i believe we will lose jobs if this passes. mr. baucus: just a brief minute would you yield? mr. barrasso: as soon as i'm finished with our comments on this side. thank you, mr. president. mr. baucus: thank you. mr. barrasso: and i also heard the majority whip come to the floor and say the republicans have only offered four amendments. mr. president, i offered 19 amendments, and so i ask unanimous consent that the pending amendment be set aside and that i be allowed to call up my amendment number 3148 to protect individuals facing skyrocketing premiums. the presiding officer: is there objection? mr. baucus: reserving the right to object. mr. barrasso: well, the purpose of this amendment, mr. president -- mr. baucus: reserving the right to object. i have not yet objected. we will object. mr. president, we have been debating this bill for --

mr. barrasso: regular order. mr. baucus: mr. president, i -- the presiding officer: is there objection to the request? mr. baucus: i object. the presiding officer: objection is heard. the senator from wyoming. mr. barrasso: we have an amendment read on the floor yesterday, that i worked my way through, along with my staff, 383 pages, and the minority -- the majority whip comes to the floor and says republicans haven't offered amendments. so i just tried to offer one unsuccessfully because it has been objected to. so i will at this time ask unanimous consent that the pending amendment be set aside and that i be allowed to call up amendment number 3153 to protect young, healthy persons from increased insurance premiums. mr. baucus: mr. president, mr. president, clearly this is a stunt. i object. the presiding officer: objection is heard. mr. barrasso: mr. president, i ask unanimous consent that the pending -- and these are not -- i just heard the comments. these are amendments that are aimed to keep the president's words that we will get insurance premiums under control, that

people will notice their premiums go down, that we will make it better for people, easier for people. the democrats want to accept all of -- don't want to accept all of these amendments because these are intended to do just that. i ask unanimous consent the pending amendment be set aside and i be allowed to call up amendment number 3146, individual mandate penalties and create personal accounts for young people who are penalized and they have to pay a fee and a fine if they don't obey the individual mandate and that that would go into an account for them so they could use that money to buy their own health insurance. mr. baucus: mr. president. the presiding officer: is there objection? mr. baucus: reserving the right to object. this is the fourth time today that senators on the other side of the aisle -- this is clearly a stunt. i object. mr. barrasso: regular order. the presiding officer: is there objection? mr. baucus: i object. the presiding officer: objection is heard. mr. barrasso: and i understand this is going to improve medicare. i have heard the chairman of the finance committee say this is going to make medicare stronger. i believe medicare patients then ought to have the freedom to

contract and have the right to privately contract for medical services with a physician of their choice. if as the president -- as the chairman of the finance committee has now recommended and has stated, if it doesn't work out the way that he would suggest. so i ask unanimous consent that the pending amendment be set aside and i be allowed to call up amendment numbered 2984, medicare patient freedom to contract. the presiding officer: is there objection? mr. baucus: for the fifth time, i object. the presiding officer: objection is heard. mr. barrasso: thank you, mr. president. that's why i'm just not surprised when i read the polls that say negative -- negatives abound in poll about this bill, written in secret, brought to us just a little over 24 hours ago with a 383-page amendment, one that is now not going to be allowed to have any amendments offered. i just offered four different amendments aimed to strengthen the health care system of the country each time, each time the chairman of the finance committee is not even interested

in hearing what the amendments are about. the people of wyoming say don't cut my medicare, don't raise my taxes, don't make things worse for me, especially in these economic times. this is a bill that is going to cut people's medicare by by $500 billion. it is going to raise their taxes, and it is going to make things worse for the people of wyoming and this country, and that's why the front page of our local newspaper had the story "doctor shortage will worsen." great concerns and even the actuary from medicare and medicaid said if all of this goes through, all of this goes through -- and this was before we had the 383 new pages, mr. president -- if all of this goes through, one in five hospitals are going to have significant problems within the next ten years. one in five doctors' offices may have to close, and that's why this health bill is scary. and for anyone who hasn't had an opportunity to read dr. coburn, senator coburn's article in "the wall street journal," an

editorial thursday, december 17, i would recommend the editorial to them. it's titled "the health bill is scary." i'd like to introduce this as a part of the record. the presiding officer: without objection. mr. barrasso: thank you. so, mr. president, here you have it. we have a bill that's going to be voted on at 1:00 in the morning on a monday morning. why? because the people who are proposing the bill are scared to let the american people know what's in it. that's why public opinion has soured on this proposal to the point that it is the lowest level ever with just -- with just 32% of americans in favor. just less than one in three. less than one in three americans support what we're -- what this is -- what's being proposed. each one of my amendments, i believe, would have raised the level of support, would have made this better for american taxpayers, for american

citizens, for american patients, for the patients who depend upon our health care system, for the providers who give the care, and for the people who pay for it. but i see my colleague from north carolina ready to rise. it is -- i'm so happy to be joined on the senate floor with these two wonderful colleagues who have a great bill of their own that has gotten very little hearing, very little opportunity, certainly no opportunity for a vote on the senate floor. and as my senate colleague from north carolina gets his microphone ready to go. i would say, mr. president, that to be held to a false deadline of christmas day, something is -- as important as a bill that's going to impact the health of every person in this country, impact 1/6 of the economy of the united states, it's much more important, mr. president, that we get it right than it gets rushed through with speed and secrecy,

with not being able to offer amendments when a 383-page amendment bill by senator reid is dropped on the table yesterday and a vote is going to be held at 1:00 in the morning on a monday morning. it's astonishing, mr. president, that we don't have bipartisan support. people working together to find solutions. it's astonishing that when you have a body like this of 100 members but two of whom were physicians with 50 years of experience practicing medicine, working with the system, fighting against insurance companies and fighting against the government, to physicians who know that you don't want anybody between you and your physician. not a government bureaucrat, not an insurance bureaucrat, you don't want anyone. what we're looking at here is the worst of all possible worlds. so, mr. president, i would ask my colleague from north carolina if he has some additional thoughts.

mr. burr: mr. president? the presiding officer: the senator from north carolina. mr. brur: i look around this chamber and i see the busts of many vice presidents who have served as the leader of this chamber, and it makes me wonder what they would think of the process that we're currently engaged in, individuals that at the time of our history of this country took so seriously what went on in this chamber and the effects that it had on the american people, and i look at the process that we're going through right now and see the way we have trivialized this process. votes in the middle of the night. you know,. mr. burr: you know, 24 hours ago, there was not a manager's amendment, there was not a score. then we yesterday morning got a manager's amendment, 380-some pages, and we got a score.

today we get a notice from the congressional budget office saying that in their score, they made a half a trillion dollars error, a $500 billion, half a trillion dollar error in the projection that they gave -- sent to congress. 24 hours, half a trillion dollars. now, why doesn't this seem to bother those that are the authors of the bill? it's because it's not their money. it's the american people's money, and that's the only way that you could rationalize how you could be in washington talking about spending spending $2.5 trillion, at best, to stop waste, fraud, and abuse. because let's face it, republicans and democrats agree there is no health care reform in here. there is a coverage expansion, but there is no health care reform.

democrats have walked to the floor and said we lie. i'm not lying. show me the health care reform. show me where you have drasticcally changed, transformed health care. if you transform health care, then you wouldn't have to steal steal $464 billion from medicare. a senator: will the senator yield? the presiding officer: the senator from north carolina has the floor. the senator from north carolina has the floor. mr. burr: i appreciate it, mr. president. we have gone through this and we're refused the ability to offer amendments. we're refused the opportunity to sit in the back room where the legislation is constructed. it's shared with us when they are ready.

but they use everybody's money. tell me how it's fair to the american people. when nebraska gets a sweetheart deal under medicaid and massachusetts and vermont in the manager's amendment, when nebraska is told we're going to expand medicaid and we're going to hold you harmless in perpetuity, you will not have to pay, tell me how that's fair to the taxpayers of virginia, tell me how it's fair to the taxpayers of ohio, tell me how it's fair to the taxpayers of north carolina, that they are going to pay for what nebraskans should be obligated to. and i believe, knowing the people of nebraska, that the people of nebraska would want to pay their share. but no, to buy a vote, they have been given a deal. well, this bill is still still $2.5 trillion. it still steals $464 billion from medicare.

it still puts a tremendous unfunded mandate on every state in this country, with the exception of the state of nebraska. there are a number of states that have a great period for some period of time, whatever it took to get their comfort level of their vote, but for every other state at some point they are going to be obligated to pick up that difference. we cover 31 million americans that weren't covered. that is a wonderful thing. 15 million of them are dumped into medicaid, the worst health care delivery system that exists in this country, a health care system that only has the opportunity today to see 60% of the available doctors because the other 40% won't see them. and oh, by the way, what did the chief actuary of the centers for medicare and medicaid services say? "the reid bill is especially likely to result in providers

being unwilling, unwilling to treat medicare and medicaid patients, meaning that a significant portion of the increased demand for medicaid services would be difficult to meet." the chief actuary went on to say -- "the c.m.s. actuary noted that the medicaid cuts in the bill -- medicare cuts in the bill could jeopardize medicare beneficiaries' access to care." i just heard the senator from rhode island basically come out and say that was a fabricated thing on somebody's part on this side of the aisle. i'm quoting the chief actuary, the president's chief health care budgetary person the actuary said "it could jeopardize medicare beneficiaries' access to care." he goes on to say he also found that roughly 20% of all part-a

providers -- hospitals, nursing homes, et cetera -- would become unprofitable within the next ten years as a result of these cuts. hospitals will close. nursing homes will khroefplts this isn't fabrication. this is the chief actuary for the center of medicare and medicaid services who is part of this administration. the c.m.s. actuary found that further reductions in medicare growth through the actions of the independent medicare advisory board -- this is the advisory board that's being set up to make determinations about coverage in the future. and the chief actuary said, "which advocates have pointed to as a central linchpin to reducing health care spending may be difficult to achieve in practice." in other words, it's not us that's making claims that aren't right. it's the authors of the bill

that are making claims that aren't accurate, according to the chief actuary. minority leader. mr. mcconnell: if that were not bad enough -- and it may have been referenced here on the floor before i came out -- we have an announcement from the congressional budget office just today that may well have been referred to by my friend from north carolina. this is a congressional budget office director's blog today. and here's the headline: "correction regarding the longer-term effects of the manager's amendment on the patient protection and affordable care act. c.b.o. has discovered an error in the cost estimate released yesterday -- yesterday -- related to the longer-term budgetary effect of the marine's amendment." they go on to say they were about a half a trillion off in looking at the long-term effects

beyond the ten-year win tkoerbgs which further illustrates why we ought not be rushing this thing through and we ought to have further opportunity to skoefr what other -- to discover what other problems are in it in addition to the ones what the senator from north carolina has outlined with regard to special treatment for some states. mr. burr: if we waited another day to vote, we might save a half a trillion dollars. that is probably in the best interest of the american taxpayers. i want to wrap up, mr. president, because i know dr. coburn wants to speak. i said earlier, this steals $464 billion from medicare. it also still raises taxes and fees to the tune of $519 billion. many of those taxes and fees, by the way, are going to impact people well below the $200,000 threshold that the president promised he would never touch. and we've just learned in the

marine's amendment that we -- in the manager's and that we dropped the doctor fix. they should be comforted in knowing they've got two months' extension, but the one-year extension was dropped in the manager's amendment. dropped. why? because they had to pay for what they were doling out to get extra votes. so, i would ask unanimous consent at this time, mr. president, to set aside the pending amendment. and i would like to call up amendment 3134, which is a three-year doctor fix of the s.g.r. and ask for its immediate consideration. the presiding officer: is there objection? mr. baucus: mr. president, for the sixth time we're engaged in this stunt. that's why i object. the presiding officer: objection is heard. mr. burr: my hope is that no other member from the other side will come to the floor and say republicans haven't come wup substantive amendments -- come up with substantive amendments to this bill. dr. coburn and i participated in

56 1/2 hours of the "help" committee. we offered numerous amendments. some technical amendments were accepted. the amendments that meant anything were rejected on party lines. we have had -- filed as a bill, comprehensive health care reform bill, the first one introduced in congress may of this year, i believe, dr. coburn. yet, still members pr-t other side come to the floor and say republicans haven't offered anything. we were the first. they may not have liked it, but we were the first. you know what? it doesn't cost this and it doesn't raise taxes. i think dr. coburn later on will talk about that bill a little bit. i was glad to see that politics comes from all sides. in the manager's amendment we dropped the tax on botox. hollywood really spoke out about this tax on one of their health care tools. and what did we replace it with?

we've now put a 10% tax on tanning salons. how in the hell does that affect health care? explain that to me. are we going to tax everything in this country? i can make a tremendous case that the 10% tanning salon tax gets exactly the person that the president said he wasn't going to effect: people that made under $200,000. or are we income testing the tanning tax too? mr. coburn: would the gentleman yield for a question? mr. burr: happy to yield. mr. coburn: if we're going to tax tanning salons, why aren't we taxing anybody that goes to the beach because true sunlight is much worse for your skin than the tanning salon. so if the intention was to prevent disease, why wouldn't we tax it where most of the diseases occurred. or how about kids' sports in the summer? let's tax kids' baseball. or swimming.

let's tax all the swimming pools because we all have exposure to u.v. light. i mean, it shows you the precariousness and the silliness of a large portion of this. and i yield back. mr. burr: the gentleman makes a great point, and i'm sure that we have loaded the chairman of the finance committee with additional good ideas that he could go back and think. i'm sure before it's over with, we'll find parents that don't put suntan lotion on their children and especially if it doesn't meet the high enough s.b.f. to block everything that the sun might produce. this is out of control. this is not the way to write a bill that affects one-sixth of the u.s. economy. i mean, it's bad enough that it's done behind closed doors in a back room with only a few people there that the number-two democrat can walk on the floor and say i haven't seen it either. if the number-two democrat hasn't seen it, how many people were there? how many people's input came

into this? was it just leader reid and senator nelson? was it the presiding officer from minnesota? nobody knows. nobody knows. but the truth is that what we do know is that the american people don't like the process. and more importantly, the american people don't like the bill. now, the chairman of the finance committee, others have said but once it's out there and they get a taste of this, they're going to like it then. let me remind my colleagues, it's too late. the chief actuary already told us hospitals are going to close, nursing homes are going to close, doctors are going to quit practicing medicine, doctors are going to quit seeing medicare and medicaid beneficiaries. how do you repair that after you've done the damage? are we willing to risk that for

the future of this country and generations yet to come? boy, we've got a few hours -- ten, eight -- before we vote. i hope people get some sense. i hope they pull back from this. let's leave for christmas. let's think about this. let's go home, let's talk to people, let's listen to people in this country. if we do, we might come back, get a new piece of paper, take some of the things that are in this bill, take some of the things we have talked about on this side of the aisle, take some of the stuff the american people have talked about. find a way for 100% of the nurses, doctors and hospitals to surenvironment find a way to have 100% of the american people to have coverage, not to leave 24 million people outside the scope of coverage. i think when we set out on this, we had three objectives. it was to cover all the american

people. we flunked. it was to invest in prevention, wellness and chronic disease management. the doctor and i would both say we haven't come anywhere close to do that. and the third one and the most important was make sure it's fiscally sustainable. c.b.o., c.m.s., wherever you want to go, the only way this is fiscally sustainable is if the independent medicare advisory board continues to cut reimbursements, the scope of coverage to meet how much we're willing to spend on health care to say it is affordable. i don't believe that's reform. i believe that's legislation that picks winners and losers, and that's not the role of the senate of the united states. i yield to the good doctor. mr. coburn: mr. president? the presiding officer: the senator from oklahoma. mr. coburn: thank you. i want to raise an issue that was raised in the finance committee markup. it was raised in the health care

markup. i have behind me the medicare cuts. i think they have been slightly reduced. we're not going to cut medicare, we're not going to cut it significantly in the fraud -- $2 billion -- that's where the real waste it. when offered the opportunity, the senator from rhode island said we were trying to scare people -- when offered the opportunity, the chairman of the committee to prohibit rationing of health care in this country, they both voted against it. just a simple straightforward saying no matter what we do in health care, we're not going to do what other countries have done and ration health care. straight up and down votes, party line votes against it that in fact we're going to ration health care. that's what this bill does. the way we're going to control costs is through the mechanisms

outlined in this bill that are going to allow government bureaucrats to decide what you can get treated for, when you can get treated for it and where you can get treated for it. and the rebuttal of that is medicare is already illegal for them to ration care, so we don't need a prohibition. well, the fact is is medicare's rationing right now. they're rationing virtual colonoscopy. they're rationing bone densioo met ry. so when given the opportunity to vote and put an absolute prohibition on the rationing of health care, what did the chairman of the finance committee do? he voted against that because what he recognizes is the ultimate plan and the answer to

senator senator burr's question is this will collapse. it's not going to be sustainable. the medicare cuts won't be made by us. we'll put it off on a commission and say oh, we had to do it, and the result of that will be rationing. and the other result will be what the senator from vermont actually wants, which is a single-payer, government-run system. that's why he's intellectually honest. he brought it to the floor and said this is how i think we ought to solve health care. we ought to have the government run it. we ought to have the government make the decisions. and he was honest about it. that's where this bill's going. so, if you're a medicare patient, you should be concerned. if you're a medicare advantage patient, you should be concerned. i've had criticism leveled at me

because i do what the chairman of the finance committee, i make competitive bidding for medicare advantage. there's a big difference. mine, with no cuts and pweufrs. they cut benefits 50%. in terms of the medicare advantage differential. there's three things you can do to fix health care in this country. you can incentivize prevention and the treatment of chronic disease based on outcome. you can create transparency so that purchasers in the market can actually make a judgment about value and quality. and you can assist those that are on the lower rungs of the economic ladder to get the same kind of care we get. those are the three things you can do. i readily admit we don't have a great competitive model in